Does AmeriHealth Insurance Cover Addiction Treatment?

If you or someone you love is struggling with addiction, one of the first questions that comes up is: “Will my insurance cover treatment?” For individuals with AmeriHealth insurance, the answer is often yes — but it depends on many factors. Your state of residence, the type of plan you have, and whether the treatment is considered medically necessary all play a role in determining coverage. At Southeastern Recovery Center, we know how important clarity is during this time, which is why we’ve created this guide to walk you through the essentials.

AmeriHealth’s Behavioral Health Coverage

AmeriHealth is a regional health insurer that provides both commercial plans and Medicaid options through AmeriHealth Caritas. One of the key features of AmeriHealth’s offerings is its inclusion of behavioral health benefits, which extend to mental health and substance use disorder services. According to AmeriHealth’s Behavioral Health Benefits, covered services may include:

  • Evaluations and diagnostic assessments
  • Individual, group, and family therapy
  • Medication management with prescribing clinicians
  • Telehealth and virtual therapy options
  • Inpatient and outpatient behavioral health treatment

AmeriHealth also operates a Connect to Care program, designed to help members access behavioral health services more quickly. In some cases, this means a patient can begin treatment within just a couple of days instead of waiting weeks. While this is a positive step forward, the level of access and speed depend on whether providers are in-network and how each plan is structured. Because each AmeriHealth plan is unique, it’s always important to verify exactly what your policy includes.

AmeriHealth’s Commercial and Medicaid Insurance Options

AmeriHealth offers both commercial insurance plans and Medicaid contracts under the AmeriHealth Caritas brand. This distinction is important because facilities like Southeastern Recovery Center may be in-network with AmeriHealth on either side — or both.

Commercial Plans:
These include employer-sponsored plans, Marketplace options, and Medicare Advantage products. Coverage under commercial contracts often provides a broader network of providers and may include higher levels of care, such as residential rehab or intensive outpatient programs. Cost-sharing (like copays and deductibles) typically applies, but members generally have more flexibility in choosing facilities.

Medicaid Plans (AmeriHealth Caritas):
Medicaid coverage is managed differently, with services coordinated through AmeriHealth Caritas and, in many states, through its partner PerformCare. These plans ensure that lower-income individuals and families still have access to substance use disorder treatment, though network participation is often narrower and prior authorization may be stricter.

For Southeastern Recovery Center, this means there are opportunities to contract with AmeriHealth under either the commercial insurance side, the Medicaid side, or both. Patients should confirm not only whether their treatment is covered, but also which type of AmeriHealth plan they hold, since coverage rules and provider networks differ between commercial and Medicaid products.

Federal Laws That Shape Coverage

Addiction treatment coverage is not just an insurer’s choice — it is required under federal law. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that health insurers treat mental health and substance use disorder services the same as other medical or surgical services. This means AmeriHealth cannot impose stricter limitations on inpatient rehab than it does on hospital stays for medical conditions.

The Affordable Care Act (ACA) also requires most non-grandfathered individual and small-group plans to include substance use disorder treatment as an essential health benefit. The Centers for Medicare & Medicaid Services (CMS) emphasizes that addiction treatment must be offered as part of essential coverage. Thanks to these protections, AmeriHealth members should expect their plans to include some level of addiction treatment, though coverage details such as day limits, prior authorization, and network restrictions will still vary.

What Types of Addiction Treatment May Be Covered

AmeriHealth’s behavioral health benefits typically include a wide range of treatment options for substance use disorders. Coverage may depend on medical necessity, prior authorization, and whether the provider is in-network. Services can include:

Detoxification and Withdrawal Management:

Often covered when a physician determines medical detox is necessary for stabilization.

Inpatient or Residential Rehabilitation:

Many plans include coverage, though day limits and pre-approvals are common.

Partial Hospitalization Programs (PHPs):

Structured treatment programs during the day, often covered as a step-down from inpatient care.

Intensive Outpatient Programs (IOPs):

Programs that provide several hours of therapy per week, usually included as a covered benefit.

Outpatient Counseling and Therapy:

Individual or group therapy sessions, though some plans may set annual limits.

Medication-Assisted Treatment (MAT):

Use of FDA-approved medications such as buprenorphine or naltrexone, depending on the plan’s formulary.

Dual-Diagnosis Care:

Coverage for individuals with both a mental health condition and a substance use disorder.

Because no two AmeriHealth plans are identical, it’s important to confirm which of these services your coverage includes before entering treatment.

How to Verify Your AmeriHealth Coverage

The best way to avoid surprises is to verify your AmeriHealth benefits before starting treatment. Here’s a process that patients and families can follow — and one that Southeastern Recovery Center can assist with:

  • Gather Insurance Information: Collect your plan name, group number, and member ID from your insurance card.
  • Call AmeriHealth Member Services: Use the phone number on the back of your card to ask about behavioral health and addiction treatment coverage.
  • Ask About Specific Services: Confirm coverage for detox, inpatient rehab, PHP, IOP, therapy, and MAT.
  • Clarify Prior Authorization Requirements: Many services require approval before treatment can begin.
  • Review Cost-Sharing: Understand your deductible, copayments, and coinsurance.
  • Request Written Documentation: Ask for your Evidence of Coverage (EOC) or Summary of Benefits.

Work With Southeastern Recovery Center: Our admissions team can verify your benefits quickly and walk you through what is and isn’t covered.

Common Coverage Challenges

Even with strong behavioral health protections, AmeriHealth patients sometimes encounter barriers to accessing care. Some of the most common challenges include:

  1. Out-of-Network Care: If Southeastern Recovery Center or another provider is not in AmeriHealth’s network, patients may face significantly higher costs. In some cases, a single-case agreement can be arranged to reduce expenses, but individuals are often still responsible for higher out-of-pocket payments.
  2. Treatment Limitations: Certain plans may impose restrictions such as caps on inpatient rehab days or the number of outpatient therapy sessions covered per year. While the Mental Health Parity and Addiction Equity Act helps prevent unfair restrictions, AmeriHealth may still require documentation showing that extended care is medically necessary.
  3. Cost-Sharing Burdens: Even when services are covered, patients are often responsible for deductibles, copayments, and coinsurance. These costs can add up quickly, especially if multiple levels of care are needed over time.

These challenges can be discouraging, but they don’t have to prevent you from accessing treatment. At Southeastern Recovery Center, our admissions team helps patients navigate these obstacles, advocate for necessary care, and ensure that insurance benefits are applied correctly.

How Southeastern Recovery Center Helps

At Southeastern Recovery Center, we know that navigating insurance coverage can be stressful, especially when urgent treatment is needed. That’s why we work directly with AmeriHealth on your behalf. Our admissions team will:

  • Verify your benefits within 24 hours
  • Confirm whether our programs are in-network with AmeriHealth
  • Submit prior authorization requests and required documentation
  • Provide upfront cost estimates so you know what to expect
  • Assist with appeals if coverage is denied or reduced

By managing these details, we help patients and families move forward with confidence, focusing on recovery instead of paperwork.

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FAQs About AmeriHealth Insurance and Addiction Treatment

Does AmeriHealth always cover addiction treatment?

Most AmeriHealth plans include some level of behavioral health and addiction treatment, but coverage varies by plan, state, and network status.

Yes, many plans include these services, though they often require prior authorization and may have day limits.

Yes, higher levels of care such as detox and inpatient rehab usually require prior approval from AmeriHealth.

You may still receive coverage, but costs could be higher. In some cases, we may request a single-case agreement on your behalf.

Yes, outpatient therapy is usually included under behavioral health coverage, though session limits or copays may apply.

Yes, patients always have the right to appeal. Our team can help you prepare documentation and advocate for extended coverage if needed.

Taking the Next Step with AmeriHealth Coverage

At Southeastern Recovery Center, we remove the guesswork by working directly with AmeriHealth to confirm your benefits, manage prior authorizations, and explain your financial responsibilities upfront. With our guidance, you’ll have the clarity and support needed to begin treatment with confidence. Recovery is possible, and understanding your AmeriHealth coverage is the first step toward a healthier future.

Contact Southeastern Recovery Center today to verify your AmeriHealth coverage and start your journey toward lasting recovery.